Neuro Flashcards
What are the main differences between adult and pediatric brains?
Brain not fully developed
Nerve cells immature
Incomplete myelination at birth
Brain cells easily damaged if blood flow and oxygenation not maintained.
What reflexes should be gone for good once they go away?
Moro and Babinski
What are early signs of increased intracrainial pressure?
headache
vision trouble
nausea/vomiting
subtle changes in vital signs
pupillary slowing
What are ICP signs for babies?
Vague
Look for: Irritability Cat-like crying Bulging fontanel Bradycardia (below 160) Cushing's triad Sluggish pupil reaction
What is cushing’s triad?
irregular respirations
widening systolic
bradycardia
What is confusion?
impaired decision making
disoriented to person, place, time
What is delirium?
State of confusion, fear, irritiability, or agitation
What is lethargy?
sleepy, rousable with moderate effort, sluggish speech
What is stupor?
Deep sleep, responds only to vigorous and repeated stimulation
What is coma?
No motor or verbal response to noxious stimuli
What is a permanent vegetative state?
permanent lost function of cerebral cortex
What is the best score for GCS?
15
What is the worst score for GCS?
3
If patient on mannitol, what labs should be monitored?
Kidney Livery Heart BMP CBC
What IV solution given to child with increased ICP?
hypertonic saline
may be more effective than mannitol for reducing ICP
What labs should be monitored for child with ICP?
electrolytes
Is it ok to suction patient with ICP?
No!!
Very contraindicated
How should ICP patient be positioned?
HOB 30 degrees
Avoid neck vein compression
Head placed midline
How should environment sound for child with ICP?
minimal or no environmental noise
Avoid stressful activities such as ___ and ___ that may increase ICP
eliciting pain
emotional stress
What meds will be given to ICP patient who is on a vent?
sedatives
analgesics
paralytics
What is epidural hematoma?
bleeding between dura and skull
hematoma formed
What is subdural hematoma?
Forms more slowly
Birth trauma, falls, shaken baby syndrome
swelling in small space makes high risk for ICP
What is cerebral edema?
24-72 hours after head trauma.
If child loses consciousness or vomits more than 3 times, see doctor!
What are the priorities for seizure patient?
Airway
Protect from injury
Medication safety
How is airway protected in seizure patient?
position on side
How is seizure patient protected from injury?
pad rails
helmet
What is medication safety for seizure patient?
SLOW IV PUSH
If going for surgery, give meds with one sip of water even if NPO
What is ketogenic diet?
high fat
low carb
What equipment should you need nearby if child is seizure?
oxygen
suction
What medications are given for seizures?
Benzo
Phenobarbitol
phenytoin (Dilantin
fosphenytoin (Cerebryx)
carbamazepine (Tegretol)
valproic acid (Depakote)
Is it ok to abruptly discontinue seizure medications?
No. Must taper down
What is status epilepticcus?
continuous seizures for up to 30 minutes
What medications are given for status epilepticcus?
rectal diazepam (Valium)
intranasal midazolam (Versed)
IV diazepam or lorazepam (Ativan)
What do we teach home management of seizures?
CPR for family members
Rectal diazepam for intractable seizures
No swimming alone
What are s/sx of Reye Syndrome?
cerebral edema
elevated liver enzymes and ammonia
What is cause of Reye Syndrome?
viral infection treated with aspirin
What meds are given if child has viral illness or fever?
acetaminophen or ibuprofen
What is hydrocephalus?
imbalance in production and absorption of CPF
What is hydrocephalus associated with?
myelomeningocele
What are s/sx of hydrocephalus?
Abnormal head growth Bulging fontanel Dilated scalp veins Separated cranial sutures Frontal enlargement SETTING SUN EYES Depressed eyes Irritability Lethargy high-pitched cry
How is hydrocephalus relieved?
Drainage of CSF from ventricles via shunt
When is the period of greatest risk for VP shunt placement?
first few months
What infections can arise from shunt infection?
meningitis
ventriculitis
septicemia
bacterial endocarditis
wound infection
shunt nephritis
How is shunt infection treated?
massive dose of IV abx or shunt removal
What is spina bifida cystica?
VISIBLE DEFECT with external saclike protrusion
What is a meningocele?
Sac contains meninges and spinal fluid but NO NEURAL ELEMENTS.
NO neurologic deficits
What is a myelomeningocele?
Sac contains meninges, spinal fluid and nerves
Where is myelomeningocele/myelodysplasia normally seen?
Anywhere along spinal column, but common in lumbar and lumbosacral areas.
What does the sac contain in myelomeningocele?
meninges
spinal fluid
nerves
Myelomeningocele is a term often used interchangeably with ___
spina bifida
If myelomeningocele located below 2nd lunar vertebra, what are the symptoms?
flaccid paralysis of lower extremities
sensory defecit
Is there uniformity on both sides of defect with myelomeningocele?
not
Myelomeningocele sac may be prone to leakage of ___ if ruptured?
CSF
What is the number one thing to prevent with myelomeningocele?
infection
When is surgical closure done of myelomeningocele?
within first 24-72 hours
What position do we place child with myelomeningocele?
prone
What neuro assessment is performed on child with myelomeningocele?
assess extremity movement and infant behavior.
Do we take rectal temperatures on baby with myelomeningocele?
no
What physical assessments are done on baby with myelomeningocele?
observe urine output
observe for abdominal distention
measure head distention
assess fontanel for bulging
How are myelomeningocele children bedded?
in isolette
no clothing
How is myelomeningocele dressed?
moist, sterile dressing
sterile water
sterile dressing
sterile gloves
sterile, sterile, sterile!!
What is cerebral palsy?
abnormal muscle tone, disorder of development of movement and posture.
Is cerebral palsy progressive?
No. The damage you see is the damage they have
What is the most common cerebral palsy?
Spastic
What is spastic cerebral palsy?
hypertonic
poor control of posture, balance, and coordinated motion
poor fine and gross motor skills
What are physical s/sx of spastic cerebral palsy?
Poor head control after 3 mo
stiff or rigid limbs
arching back, pushing away
floppy tone
unable to sit without support at 8 months
clenched fists after 3 months
What are behavioral s/sx of spastic cerebral palsy?
Excessive irritability
no smiling by 3 months
persistent tongue thrusting
frequent gagging or choking with feeds
What are goals of therapy for CP patients?
Helping them maintain function and be as normal as possible:
establish locomotion, communication, and self-help skills
gain optimal appearance and integration of motor functions
correct associated defects as effectively as possible
provide educational opportunities adapted to child’s capabilities
promote socialization experiences
achieve max independence
What are some therapeutic management for CP?
Ankle/foot braces
orthopedic surgery to correct spastic deformities
PT/OT
What is neuroblastoma ?
malignant extracranial tumor
Where can neuroblastoma develop?
Anywhere along SNS chain:
abdomen
adrenal
thoracic
cervical
